FORM 10

FORM FOR NOMINATION/ CANCELLATION OF NOMINATION

(To be filled in by individual applying singly or jointly)

Date 2 4 M A Y 20 2 3 DP ID I N 3 0 3 1 1 6 Client id 7 0 2 8 0 0 9 4

P I/We wish to make a nomination. [As per details given below]

I/We wish to cancel the nomination made by me/ us earlier and consequently all rights and liabilities in respect
of beneficiary ownership in the securities held by me / us in the said account shall vest in me/ us.
[Strike off the nomination details below]
Nomination Details
I/We wish to make a nomination and do hereby nominate the following person(s) who shall receive all securities held in the Depository by me / us in the
said beneficiary owner account in the event of my / our death.
Nomination can be made upto three Details of 1st Nominee Details of 2nd Nominee Details of 3rd Nominee
nominees in the account.
1 Name of the nominee(s)
(Mr./Ms.) Sunita Padmakumar

2 Share of each Equally 100 % % %

Nominee
[If not equally,
please specify
percentage] Any odd lot after division shall be transferred to the first nominee mentioned in the form.
3 Relationship With the
Applicant ( If Any)
Spouse
4 Address of Nominee(s) 739,D3, SUPRABHAT CHS,
SECTOR-7, CHARKOP,
KANDIVALI WEST,
MUMBAI

PIN Code 400 067

5 Mobile/Telephone No. of
nominee(s)
9819435273
6 Email ID of nominee(s) sunitapk80@gmail.com
7 Nominee Identification details
–[Please tick any one of
following and provide details of
same]

Photograph & Signature

P PAN / Aadhaar Card no.

Saving Bank account no.

Proof of Identity

Demat Account ID

Sr. Nos. 8-14 should be filled only if nominee(s) is a minor:

8 Date of Birth {in case of minor
nominee(s)} na

9 Name of Guardian (Mr./Ms.)

{in case of minor nominee(s) } na
10 Address of Guardian (s) na

PIN Code
11 Mobile/Telephone no. of
Guardian na
12 Email ID of Guardian na
13 Relationship of Guardian with
nominee na
14 Guardian Identification
details –[Please tick any one of
following and provide details of na
same]

Photograph & Signature

PAN Aadhaar

Saving Bank account no.

Proof of Identity

Demat Account ID

Name(s) of holder(s) Signature(s) of holder

Sole/ First Holder (Mr./Ms.) Padmakumar Thankappan Padmam X

Second Holder (Mr./Ms.) X

Third Holder (Mr./Ms.) X

Signature of Witness for Nomination

Name of the Witness Address Signature of witness

Date
Notes:
1. The nomination can be made only by individuals holding beneficiary owner accounts on their own behalf singly or jointly. Non- individuals
including society, trust, body corporate and partnership firm, karta of Hindu Undivided Family, holder of power of attorney cannot nominate. If
the account is held jointly, all joint holders will sign the nomination form.
2. A minor can be nominated. In that event, the name and address of the Guardian of the minor nominee shall be provided by the beneficial owner.
3. The Nominee(s) shall not be a trust, society, body corporate, partnership firm, karta of Hindu Undivided Family or a power of Attorney holder.
A non-resident Indian can be a Nominee, subject to the exchange controls in force, from time to time.
4. Nomination in respect of the beneficiary owner account stands rescinded upon closure of the beneficiary owner account. Similarly, the
nomination in respect of the securities shall stand terminated upon transfer of the securities.
5. Transfer of securities in favour of a Nominee(s) shall be valid discharge by the depository and the Participant against the legal heir.
6. The cancellation of nomination can be made by individuals only holding beneficiary owner accounts on their own behalf singly or jointly by the
same persons who made the original nomination. Non- individuals including society, trust, body corporate and partnership firm, karta of Hindu
Undivided Family, holder of power of attorney cannot cancel the nomination. If the beneficiary owner account is held jointly, all joint holders
will sign the cancellation form.
7. On cancellation of the nomination, the nomination shall stand rescinded and the depository shall not be under any obligation to transfer the
securities in favour of the Nominee(s).
8. Nomination can be made upto three nominees in a demat account. In case of multiple nominees, the Client must specify the percentage of share
for each nominee that shall total upto hundred percent. In the event of the beneficiary owner not indicating any percentage of allocation/share
for each of the nominees, the default option shall be to settle the claims equally amongst all the nominees.
9. On request of Substitution of existing nominees by the beneficial owner, the earlier nomination shall stand rescinded. Hence, details of
nominees as mentioned in the FORM at the time of substitution will be considered. Therefore, please mention the complete details of all the
nominees.
10. Copy of any proof of identity must be accompanied by original for verification or duly attested by any entity authorized for attesting the
documents, as provided in Annexure D.
11. Savings bank account details shall only be considered if the account is maintained with the same participant.
12. DP ID and client ID shall be provided where demat details is required to be provided.